农村晚期肺癌化疗患者心理困扰与应对方式的调查研究
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摘要
目的研究调查农村晚期肺癌患者化疗阶段心理困扰和应对方式的现状。方法 (1)量性研究:采取便利取样法选择安徽医科大学附属安庆医院住院化疗的107位农村肺癌晚期患者,用一般情况调查表、心理困扰筛查工具和癌症应对方式量表进行调查;(2)质性研究:对量性研究中心理困扰得分大于或等于4分的9例农村晚期肺癌化疗患者进行半结构式深度访谈,运用内容分析法分析资料。结果 (1)60.7%的患者心理困扰得分大于或等于4分,有无疼痛及不同人均月收入水平的患者心理困扰得分比较差异有统计学意义(P<0.01)。面对与心理困扰呈负相关(r=-0.320,P<0.01),幻想、屈服与心理困扰呈正相关(r=0.247、0.314,P<0.05);(2)心理困扰体验包括:因化疗不良反应而无奈,因对不可预知的未来的恐慌,因难以胜任病前角色,因巨大的经济压力而自责,因难以获得支持与帮助而绝望,有巨大的精神压力;应对体验归纳为:积极寻求帮助,屈服,压抑,幻想奇迹出现等。结论农村晚期肺癌化疗患者心理困扰较为普遍且主观体验复杂多变,应对方式与心理困扰存在相关性。
Objective To investigate the current situation of psychological distress and coping styles during chemotherapy stage in rural patients with advanced lung cancer.Methods(1)The quantitative research:107 rural inpatients with advanced lung cancer treated by chemotherapy in Affiliated Anqing Hospital of Anhui Medical University were selected by adopting the convenient sampling method,and conducted the survey by using the General Condition Questionnaire,the Psychological Distress Screening Tools,and the Cancer Coping Modes Scale.(2)The qualitative study:in the comparison of psychological stress score for the quantitative study,9 rural cases of lung cancer undergoing chemotherapy with in the comparison of psychological stress score≥4 points conducted the semi-structured in-depth interviews.The interview data were analyzed by using the content analysis.Results(1)60.7% of the patients had a psychological distress score≥4 points.The scores of psychological distress had statistically significant difference between the patients with or without pain and among the patients with different average monthly incomes(P<0.01).The confrontation was negatively correlated with psychological distress(r=-0.320,P<0.01),while fantasy and surrender were positively correlated with psychological distress(r=0.247,0.314,P<0.05).(2)The psychological distress experience included:helplessness due to adverse reactions of chemotherapy,panic about the unpredictable future,self-blame for being incapable of pre-existing roles and huge economic pressure,despair due to difficulty in obtaining support and help,which had enormous mental stress.The coping experience included:actively seeking help,yielding,depression,and fantasy for miracle appearance.Conclusion The psychological distress is prevalent and the subjective feelings are complex and changeable in rural patients with advanced lung cancer treated by chemotherapy.The coping styles are related to psychological distress.
Objective To investigate the current situation of psychological distress and coping styles during chemotherapy stage in rural patients with advanced lung cancer.Methods(1)The quantitative research:107 rural inpatients with advanced lung cancer treated by chemotherapy in Affiliated Anqing Hospital of Anhui Medical University were selected by adopting the convenient sampling method,and conducted the survey by using the General Condition Questionnaire,the Psychological Distress Screening Tools,and the Cancer Coping Modes Scale.(2)The qualitative study:in the comparison of psychological stress score for the quantitative study,9 rural cases of lung cancer undergoing chemotherapy with in the comparison of psychological stress score≥4 points conducted the semi-structured in-depth interviews.The interview data were analyzed by using the content analysis.Results(1)60.7% of the patients had a psychological distress score≥4 points.The scores of psychological distress had statistically significant difference between the patients with or without pain and among the patients with different average monthly incomes(P<0.01).The confrontation was negatively correlated with psychological distress(r=-0.320,P<0.01),while fantasy and surrender were positively correlated with psychological distress(r=0.247,0.314,P<0.05).(2)The psychological distress experience included:helplessness due to adverse reactions of chemotherapy,panic about the unpredictable future,self-blame for being incapable of pre-existing roles and huge economic pressure,despair due to difficulty in obtaining support and help,which had enormous mental stress.The coping experience included:actively seeking help,yielding,depression,and fantasy for miracle appearance.Conclusion The psychological distress is prevalent and the subjective feelings are complex and changeable in rural patients with advanced lung cancer treated by chemotherapy.The coping styles are related to psychological distress.
引文
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[13]黄雪薇,郭宝江,王秀利,等.癌症应对问卷的编制与测评[J].中国心理卫生杂志,2007,21(8):517-520.
[14]刘晓芯,刘盛怡,朱渊,等.肺癌病人心理控制源、应对方式与心理痛苦现状研究[J].护理研究,2015,29(3):324-326.
[15]张甜,吕晓晴,何红叶,等.安徽省三级医院肺癌患者支持性照护需求调查分析[J].中华疾病控制杂志,2018,22(6):645-647.
[16]洪静芳,张伟,宋永霞,等.老年癌症患者心理困扰的现况调查[J].中华护理杂志,2015,50(1):92-96.
[17]李亚运,钱东福,周守君,等.某地区肺癌住院患者直接经济负担城乡差异比较研究[J].重庆医学,2016,45(5):661-663.
[18]李月.肺癌患者家庭功能与应对方式,抑郁状态的调查与分析[D].北京:北京中医药大学,2012.
[19]谷培培.食管癌化疗患者生活质量及影响因素分析[D].济南:山东大学,2017.
[20]魏曾曾.胃癌患者围手术期心理困扰影响因素及治疗性沟通系统干预效果研究[D].合肥:安徽医科大学,2011.
[21]陈梅,尚少梅,王秀华,等.晚期肺癌患者化疗期间舒适状况与社会支持、应对方式的关系[J].护理管理杂志,2012,12(2):80-82.
[22]徐文博.老年喉癌术后患者生存质量与社会支持及其主要照顾者应对方式的相关性研究[J].重庆医学,2017,46(17):2396-2398.
[2]刘永军,杨婵婵.我国肺癌流行趋势及疾病负担概况[J].现代商贸工业,2016,28(2):212-213.
[3]李慧.肺癌的治疗现状及研究新进展[J].实用中西医结合临床,2015,15(5):91-93.
[4] HINZ A,KRAUSS O,HAUSS J P,et al.Anxiety and depression in cancer patients compared with the general population[J].Eur J Cancer Care(Engl),2010,19(4):522-529.
[5]吴柳艳,鄢敏英.肺癌患者的心理困扰程度及相关因素[J].当代护士(中旬刊),2015(1):149-150.
[6] HOLLAND J C,ANDERSEN B,BREITBART W S,et al.Distress management[J].J Natl Compr Canc Net,2013,11(2):190-209.
[7] THIAGARAJAN M,CHAN C M,FUANG H G,et al.Symptom prevalence and related distress in cancer patients undergoing chemotherapy[J].Asian Pac J Cancer Prev,2016,17(1):171.
[8] BURRIS J L,ANDRYKOWSKI M.Disparities in mental health between rural and nonrural cancer survivors:apreliminary study[J].Psychooncology,2010,19(6):637-645.
[9] ELSHESHTAWY E A,ABO-ELEZ W F,ASHOUR H S,et al.Coping strategies in Egyptian ladies with breast cancer[J].Breast Cancer Basic Clin Res,2014(8):97-102.
[10]金梅.胃癌化疗期患者心理困扰影响因素及预实验干预研究[D].合肥:安徽医科大学,2015.
[11]OANCEA C,SUCIU C,TIMAR B,et al.The reciprocal relationship between coping mechanisms and lung cancer diagnosis:findings of a prospective study[J].Cancer Manag Res,2018(10):33-40.
[12]张伟.中文版癌症患者心理困扰筛查工具的修订及其最佳临界值的研究[D].合肥:安徽医科大学,2012.
[13]黄雪薇,郭宝江,王秀利,等.癌症应对问卷的编制与测评[J].中国心理卫生杂志,2007,21(8):517-520.
[14]刘晓芯,刘盛怡,朱渊,等.肺癌病人心理控制源、应对方式与心理痛苦现状研究[J].护理研究,2015,29(3):324-326.
[15]张甜,吕晓晴,何红叶,等.安徽省三级医院肺癌患者支持性照护需求调查分析[J].中华疾病控制杂志,2018,22(6):645-647.
[16]洪静芳,张伟,宋永霞,等.老年癌症患者心理困扰的现况调查[J].中华护理杂志,2015,50(1):92-96.
[17]李亚运,钱东福,周守君,等.某地区肺癌住院患者直接经济负担城乡差异比较研究[J].重庆医学,2016,45(5):661-663.
[18]李月.肺癌患者家庭功能与应对方式,抑郁状态的调查与分析[D].北京:北京中医药大学,2012.
[19]谷培培.食管癌化疗患者生活质量及影响因素分析[D].济南:山东大学,2017.
[20]魏曾曾.胃癌患者围手术期心理困扰影响因素及治疗性沟通系统干预效果研究[D].合肥:安徽医科大学,2011.
[21]陈梅,尚少梅,王秀华,等.晚期肺癌患者化疗期间舒适状况与社会支持、应对方式的关系[J].护理管理杂志,2012,12(2):80-82.
[22]徐文博.老年喉癌术后患者生存质量与社会支持及其主要照顾者应对方式的相关性研究[J].重庆医学,2017,46(17):2396-2398.